MEDICARE: ROBERT KELECHUKWU EZEMA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1194964	TX

General Provider Information

NPI Number	:	1164388112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT KELECHUKWU EZEMA PMHNP-BC

Provider Business Mailing Address
First Line	:	1406 MIGRATION WAY
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6559
Country	:	US
Telephone Number	:	314-410-7921
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 SWISS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-0010
Country	:	US
Telephone Number	:	214-764-7986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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